A stroke can come on suddenly and without warning. But in some cases, people may experience early warning signs and symptoms hours or even days before a full stroke occurs. Recognizing these pre-stroke symptoms and getting immediate medical care can prevent a stroke from happening or greatly reduce the damage caused if one does occur.
What are the early signs and symptoms of an oncoming stroke?
Some common pre-stroke symptoms and warning signs can include:
- Sudden severe headache with no known cause
- Temporary loss of vision, blurred or dimmed vision, or double vision
- Numbness, weakness or paralysis on one side of the face or body
- Slurred speech or trouble speaking or understanding speech
- Dizziness, loss of balance or coordination, or trouble walking
- Confusion or trouble understanding people
Other signs can include:
- Sudden nausea or vomiting
- Ringing in the ears
- Fatigue or very low energy
- Memory loss
- Mood changes like unexplained anxiety or fear
Why do these symptoms happen before a full stroke occurs?
There are a few reasons why someone may experience pre-stroke symptoms:
- A blood clot or plaque buildup is beginning to block an artery leading to or in the brain. As the blockage starts, it can cause mini-strokes or temporary lapses in blood flow, resulting in stroke-like symptoms that resolve.
- The blood vessels in the brain are starting to rupture and leak, putting pressure on surrounding areas. This leads to symptoms like headache or vision changes.
- The blood flow to part of the brain is very slowly being restricted due to progressive narrowing of blood vessels. The gradual reduction in blood and oxygen causes subtle neurological symptoms.
In each of these cases, a full stroke is likely to occur soon if the underlying blood vessel issue is not treated immediately.
What does it feel like when these warning signs and symptoms first start?
The specific sensations and feelings associated with pre-stroke symptoms can vary depending on the area and severity of the brain affected. But in general, some of the ways it may feel when early signs and symptoms first begin include:
- Sudden excruciating headache: This can feel like the worst headache of your life starting very quickly, sometimes described as a thunderclap headache. The pain is typically severe, sharp, or explosive and may be focused on one side of the head or throughout the skull.
- Vision loss: You may experience blurred or double vision, or a graying, dimming or blackening of vision in one or both eyes. It may feel like you’re looking through fogged glasses or a dirty windshield.
- Numbness on one side: You may feel pins and needles tingling, prickling, or a gradual deadening of sensation on one side of your face, arm, or leg. The numbness can spread and may become a complete lack of sensation.
- Weakness on one side: You may have sudden muscle weakness or paralysis, causing an inability to move or control one side of your face, arm or leg. The weakness may come and go at first.
- Dizziness: This can feel like the room is spinning or moving around you. You may feel unsteady on your feet, and have difficulty walking or sitting up without falling over.
- Slurred speech: Your speech may become garbled or scrambled. You know what you want to say, but the words come out wrong, distorted, or indecipherable.
In addition to physical sensations, you may also experience:
- Confusion, disorientation, difficulty understanding others
- Sudden memory loss or forgetfulness
- Fear, anxiety, agitation, loss of inhibition
- Lack of energy, extreme fatigue, malaise
How long do these early symptoms and signs last?
The duration and course of pre-stroke symptoms can vary:
- They may last just a few minutes and then disappear if blood flow is restored through the blockage. But this indicates a high risk of an imminent stroke.
- Symptoms may come and go over the course of hours or days, showing that a stroke is probably on the horizon.
- In some cases, symptoms may linger or slowly progress for days or longer as a stroke develops over time.
Even if early symptoms are fleeting or intermittent, it’s critically important to seek emergency care. Lingering damage can still be occurring each time symptoms occur. Calling for an ambulance at the first sign of symptoms saves precious time if a stroke does happen.
What should you do if you experience these pre-stroke warning signs?
If you develop any sudden onset of the symptoms discussed, even if they seem minor or go away quickly, you should:
- Call 911 or your local emergency number immediately. Every minute counts when intervening early in a stroke.
- Note the time when symptoms first started. This helps doctors determine treatment options.
- Ask someone to drive you to the hospital or go by ambulance. Do not drive yourself.
- Stay calm and focus on getting medical care quickly. Changes can still be reversed.
- Stay put if symptoms start to go away. Still call 911 and go to the hospital.
- Take aspirin if advised by a doctor. This can help keep clots from getting bigger.
- Get care immediately even if symptoms have resolved. Urgent diagnosis and care are essential.
Can these early symptoms be prevented with lifestyle changes?
Making certain lifestyle modifications may help reduce your risk of experiencing warning signs of an oncoming stroke. Recommended preventive measures include:
- Quitting smoking and avoiding secondhand smoke
- Exercising regularly with doctor’s approval
- Eating a diet low in sodium and high in fruits, vegetables
- Drinking alcohol sparingly, if at all
- Managing chronic conditions like high blood pressure, diabetes, high cholesterol
- Taking medications for high blood pressure as prescribed
- Losing excess weight if overweight or obese
- Reducing stress through relaxation techniques and physical activity
Talk with your doctor about an appropriate stroke prevention plan for you. Controlling risk factors through lifestyle and medical management is key.
What are the types of stroke that can produce warning signs and symptoms?
The two main types of stroke that can cause pre-stroke symptoms are:
- Ischemic stroke: This occurs when an artery is blocked by a blood clot or plaque buildup, reducing blood flow. Warning signs happen as the blockage begins to form.
- Hemorrhagic stroke: This is caused by bleeding into the brain from a ruptured blood vessel. Symptoms are due to pressure from bleeding before rupture is complete.
Less commonly, warning signs and symptoms can also develop with:
- A transient ischemic attack (TIA), which is a brief temporary disruption of blood flow.
- A vascular malformation that puts pressure on brain tissue.
- A brain tumor occupying space and compressing areas of the brain.
Do warning signs always occur before a major stroke?
Not always. While many people experience early signs of an impending stroke, in some cases a major stroke occurs suddenly with no advance warning:
- Up to 40% of ischemic stroke victims had no obvious warning signs in the hours or days prior.
- Hemorrhagic strokes are even less likely to have early symptoms before they occur.
- Some forms of lacunar strokes affecting smaller arteries deep in the brain have no warning symptoms initially.
Even without advance warning, urgent treatment right after a stroke greatly improves outcomes. So be aware of sudden stroke symptoms and always call 911 immediately if you notice facial drooping, arm weakness, or speech difficulties.
How are pre-stroke warning signs evaluated by doctors?
Doctors use several strategies to evaluate warning signs of an impending stroke, determine the cause, and decide on urgent treatment steps:
- Physical exam: Checks vision, muscle strength, coordination and symptoms. Can show signs of blocked blood vessels.
- Brain and vascular imaging: CT scans, MRI scans, angiograms and other tests check for clots, brain tissue damage, bleeding, tumors and blood vessel problems.
- Blood tests: Helps rule out other causes like infection and identify risk factors like cholesterol levels.
- Heart tests: EKGs, echocardiograms and heart monitors identify irregular heart rhythms like atrial fibrillation that can cause clotting.
- Carotid ultrasound imaging: Looks for narrowing and plaque buildup in the main arteries that supply blood to the brain.
Results from these tests direct urgent treatment to intervene before a disabling stroke occurs.
What emergency treatments can help if warning signs are detected?
Several emergency treatment approaches may be used to try to prevent an imminent stroke or stop one in progress when warning signs are recognized early on:
- Blood thinners or clot-busting drugs: Can help dissolve clots blocking blood flow to the brain.
- Endovascular procedures: Mechanically extracts clots in blocked arteries using special catheter devices.
- Stents or carotid endarterectomy: Opens up narrowed carotid arteries to increase blood flow to the brain.
- Anticoagulants: Medications like aspirin or heparin prevent existing clots from enlarging and new ones from forming.
- Controlling blood pressure: Helps decrease pressure on weakened blood vessels to prevent rupture and bleeding.
The choice of treatment depends on the cause and type of impending stroke identified through urgent medical testing.
How effective is emergency treatment when given right after warning symptoms start?
Acting quickly at the first sign of pre-stroke symptoms offers the best chances of preventing a major stroke or significantly reducing disability if one occurs. Data shows:
- About 1 in 3 people who have a TIA go on to have a stroke, half occurring within 2 days after the TIA.
- Prompt treatment after TIA symptoms can reduce the risk of a major stroke by 80-90% in the next few days or weeks.
- Clot-busting drugs can completely reverse impending stroke symptoms and prevent stroke damage in about 1/3 of patients treated urgently.
- Endovascular treatment for blocked vessels can fully restore blood flow before permanent injury sets in.
Immediate medical care as warning signs develop is crucial. Don’t wait for symptoms to go away on their own.
What are the consequences of ignoring pre-stroke warning symptoms when they happen?
Disregarding early signs of an oncoming stroke can have devastating consequences even if symptoms quickly disappear at first:
- A disabling stroke causing permanent effects like paralysis, loss of speech, cognitive impairment and other disabilities could occur days or weeks later.
- Brain damage can silently progress each time symptoms occur and resolve.
- A blocked artery or vessel rupture may suddenly worsen, triggering a major stroke with no further warning.
- Opportunities to prevent or intervene before severe injury sets in are missed.
- Treating a full stroke with permanent damage is less effective than intervening early on.
Don’t dismiss transient pre-stroke symptoms – seek emergency care immediately at the earliest sign of trouble.
What should you tell the emergency room doctor about your symptoms?
Be prepared to give ER doctors detailed information about your symptoms and history. Important details to communicate include:
- When the symptoms started and how long they lasted
- What you were doing when they began
- Which specific symptoms occurred and how severe they were
- If you’ve had similar episodes before
- Existing medical conditions you have
- Medications you take, including dosage
- Family history of stroke, heart disease, or vascular risk factors
Providing a complete and accurate picture will help guide urgent diagnosis and treatment decisions.
How are pre-stroke warning symptoms different from a TIA?
There is some overlap between early stroke symptoms and what happens in a TIA (transient ischemic attack):
- Similarities: Both can cause slurred speech, limb weakness, numbness, vision changes, dizziness, headache, and confusion.
- Differences: TIAs resolve completely within 24 hours, while pre-stroke symptoms may linger or progress.
More importantly, both require calling 911 and urgent treatment. Getting medical help quickly offers the best chance of preventing a disabling stroke.
Can you have a TIA without realizing it at first?
Yes, it’s possible to have a TIA without initially recognizing it. Reasons why include:
- Symptoms may be mild or localized, like a brief numbness in one hand.
- Episodes can happen during sleep and only last a few minutes.
- Lack of awareness means the symptoms aren’t noticed or just feel “strange.”
- Cognitive or speech effects may not be apparent to the person affected.
- Symptoms like dizziness or headache are ignored or attributed to other causes.
But it’s still vital to see a doctor if any unexplained neurological symptoms occur suddenly. Getting checked out and treated can prevent a future stroke.
Conclusion
Noticing and acting on the earliest warning signs and symptoms of an impending stroke can make a profound difference in outcome and disability. Don’t wait for symptoms to resolve or prolong themselves – call 911 at the very first signs of trouble. With urgent evaluation and treatment, permanent damage and disability can often be averted by intervening when just the warning bells are sounding, before a full stroke strikes.